Laparoscopy is a technique for performing surgery in body cavities, such as an abdomen, without making a major incision or opening. Two or more spaced apart small openings are made in the body and trocar sheaths or tubes are inserted through each opening. Various instruments are then inserted through these tubes to perform the surgery.
Examples of the types of operations performed are: biopsy and electrocoagulation; lysis of adhesions with electrocoagulation; ovarian follicle aspiration; biopsy of the ovary; ovarian cyst aspiration; electrocoagulation of bleeding points such as bleeding corpus luteum; biopsies in general; and excision of small tumors with electrocoagulation.
In some of these procedures, difficulties have been encountered when blood vessels are cut and bleeding occurs. This complicates the procedure and may endanger the patient because of the prior inability to suture and ligate with laparoscopic procedures.
Accordingly, instruments and methods have been previously developed for performing laparoscopic procedures such as those disclosed in U.S. Pat. Nos. 3,871,379 and 3,763,860. These methods require at least three different instruments to perform the laparoscopic procedure. These instruments usually include a first combined laparoscopic needle and forceps, a second combined laparoscopic tissue forceps, suture guide and cutter, and a third laparoscopic ligator.
Generally, the first and second forceps are manipulated to pierce portions of tissue, pass the suture through the tissue and withdraw both ends of the suture through one trocar to the exterior of the body. Then outside of the body the free ends of the suture are tied together to form a loose tie to ligate the tissue. The loose tie is then introduced by a third instrument, usually a ligator, through the associated trocar sheath, down to the central portion of the suture to secure the tie. After the tie is tensioned to produce a knot, the third ligator is withdrawn from its associated trocar tube. These steps are repeated for each stitch needed to ligate the tissue. Then the second forceps is reinserted into the associated trocar tube to cut the free ends of the suture to complete the procedure.
It is extremely important in procedures of this type to avoid tearing the tissue, to be able to adequately tension or draw each tie snugly up to the tissue to prevent subsequent bleeding and, to complete the ligation process as quickly as possible. Unfortunately, it is cumbersome to use these three instruments to snugly tie each stitch.